BlueCare℠ ClassicSG Choice 2

When you choose a health insurance plan, you want to get the most out of your health care dollars – today, more than ever. Blue Cross and Blue Shield of Kansas developed BlueCare plans with you in mind. BlueCare helps put you in control of your health care.

Exclusions: Following is a list of common non-covered services. For a complete list of limitations and exclusions, refer to your contract.

Duplicate benefits provided under federal, state or local laws, regulations or programs except Medicaid; services involving cosmetic or reconstructive surgery (except as stated in the contract); charges for personal items; convalescent or custodial care or rest care; all keratotomy procedures; blood or payments to donors of blood; any service or supply related to the medical management of obesity, except services covered as preventive health benefits; services related to the reversal of sterilization procedures; any medically-aided insemination procedure; charges for services by immediate relatives or by members of the household; acupuncture and admission for acupuncture; medically unnecessary services and admissions; services covered and payable under any medical expense payment provision of any automobile insurance policy; mental illness or substance use disorder services provided by a non-eligible provider; services, supplies or treatments not specifically listed as covered in the member’s contract.

Pediatric Dental (included for ages 0-19)

Sealants - One time a year per toothLimitations include occlusal surface only, teeth must be free of caries (tooth decay), not covered when placed over restoration.

Space maintainers - One time per yearCovered when medically indicated due to premature loss of posterior primary tooth; recementation not covered within six months of initial placement.

Diagnostic Services

Periodic dental evaluation - Covered 100%, once every six months

Comprehensive evaluation - One per insured, per dentist per lifetime

X-rays

Bitewing

Full mouth and panoramic - Once every three years

Treatment Services

Fillings

Silver amalgam

Tooth colored composite

Crowns

Stainless steel - Once per 24 months per tooth

Metal only, metal/porcelain or porcelain only - Once per 60 months per tooth An approval process (known as "prior authorization") for determining if services will be considered for payment is required for all crowns except stainless steel.

Root canals

Root canals on baby teeth - One per tooth per lifetime

Root canals on permanent teeth - One per tooth per lifetime

The treatment services listed below also require prior authorization to be considered for payment.

Benefit Period - The 12-month period based on the group anniversary month.

Waiting Period - Businesses select a waiting period option.

Dual Option PlanThe Dual Option Plan is available to groups of 2 to 50 employees with this product. The plan offers employees one of two out-of-pocket choices annually. This provides employees the option to "buy up" to a better level of coverage, based on their personal insurance needs.

More InformationContact us to learn more about the features of ClassicSG Choice 2.